Provider Demographics
NPI:1770677221
Name:SHEILS, MELANIE RUTH (DDS)
Entity Type:Individual
Prefix:DR
First Name:MELANIE
Middle Name:RUTH
Last Name:SHEILS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:MELANIE
Other - Middle Name:SHEILS
Other - Last Name:VERGELDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:19710 W 13 MILE RD
Mailing Address - Street 2:#103
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48025-5168
Mailing Address - Country:US
Mailing Address - Phone:248-417-2187
Mailing Address - Fax:
Practice Address - Street 1:19710 W 13 MILE RD
Practice Address - Street 2:#103
Practice Address - City:BEVERLY HILLS
Practice Address - State:MI
Practice Address - Zip Code:48025-5168
Practice Address - Country:US
Practice Address - Phone:248-417-2187
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2019-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI165941223G0001X
MI29010165941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4935792Medicaid